Korean J Urol.  2009 Aug;50(8):791-796. 10.4111/kju.2009.50.8.791.

Significance of Intraprostatic Inflammation in Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia

• Jung W
• Choi MS
• Chang HS
• Park CH
• Kim CI

• KMID: 1780484
• DOI: http://doi.org/10.4111/kju.2009.50.8.791

Abstract

PURPOSE
Histological evidence of intraprostatic inflammation is a common finding of transrectal ultrasonography (TRUS)-guided needle biopsy of the prostate in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH). The aim of this study was to evaluate the relationship between intraprostatic inflammation and lower urinary tract symptoms depending on the severity of intraprostatic inflammation. MATERIALS AND METHODS: Between January 2002 and December 2006, 141 BPH patients with prostate-specific antigen (PSA) of 4.0-10.0 ng/ml underwent TRUS-guided biopsy of the prostate. The extent and aggressiveness of intraprostatic inflammation were classified into 4 grades. The relationship between the grades of extent and aggressiveness of inflammation and the International Prostate Symptom Score (IPSS) was evaluated. The IPSS was evaluated according to voiding and storage symptom scores. RESULTS: Mean storage symptom scores were increased by grade of the extent of intraprostatic inflammation (grade 0, 6.3; grade 1, 10.1; grade 2, 11.0; and grade 3, 11.3) (p<0.001). The aggressiveness of intraprostatic inflammation also showed increasing storage symptom scores with grade (grade 0, 6.3; grade 1, 10.2; grade 2, 10.9; and grade 3, 11.6) (p<0.001). Voiding symptom scores had no relationship with extent or aggressiveness of intraprostatic inflammation (p=0.942 and p=0.449, respectively). CONCLUSIONS: BPH patients with intraprostatic inflammation complained of more severe storage symptoms than did patients without inflammation. Therefore, if storage symptoms are severe, we might consider medical treatment for intraprostatic inflammation in BPH patients.

Keyword

Prostatic hyperplasia; Pathology; Inflammation; Biopsy

MeSH Terms

Biopsy
Biopsy, Needle
Humans
Inflammation
Lower Urinary Tract Symptoms
Prostate
Prostate-Specific Antigen
Prostatic Hyperplasia
Prostate-Specific Antigen

Figure

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  Fig. 1 Extent of chronic inflammation was graded on a 4-point scale. (A) Grade 0 - no inflammation (H&E, ×100). (B) Grade 1 - scattered inflammatory cell infiltrate within the stroma without lymphoid nodules (H&E, ×100). (C) Grade 2 - nonconfluent lymphoid nodules (H&E, ×100). (D) Grade 3 - large inflammatory areas with confluence of infiltrate (H&E, ×100).

• 

  Fig. 2 Aggressiveness of chronic inflammation was graded on a 4-point scale. (A) Grade 0 - no inflammation (H&E, ×400). (B) Grade 1 - contact between inflammatory cell infiltrate and glandular epithelium (however, minimal epithelium dissociation can be observed without disruption) (H&E, ×400). (C) Grade 2 - interstitial inflammatory infiltrate associated with a clear but limited (less than 25% of the examined material) glandular epithelium disruption (H&E, ×400). (D) Grade 3 - glandular epithelium disruption on more than 25% of the examined material (H&E, ×400).

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